It is very difficult to perform total knee arthroplasty (TKA) for severe varus bowing deformity of femur. We performed simultaneous combined femoral supra-condyle valgus osteotomy and TKA for the case had bilateral varus knees with bowing deformity of femurs. A 62-year-old woman consulted our clinic with bilateral knee pain and walking distability. She was diagnosed rickets and had bilateral severe varus bowing deformity of femurs from an infant. Her height was 133 cm and body weight was 51 kg. Bilateral femur demonstrated severe bowing and her knee joint demonstrated varus deformity with medial joint line tenderness, no local heat, and no joint effusion. Bilateral knee ROM was 90 degrees with motion crepitus. Bilateral lower leg demonstrated mild internal rotation deformity. Bilateral JOA knee score was 40 Roentgenogram demonstrated knee osteoarthritis with incomplete development of femoral condyle. Mechanical FTA angles were 206 degree on the right and 201 on the left. She was received right simultaneous femoral supra-condyle valgus osteotomy with TKA was performed at age 63. Key points of surgical techniques were to use the intramedullary guide for valgus osteotomy as temporary reduction and fixation then performed mono-cortical locking plate fixation. Several mono cortical screws were exchanged to bi-cortical screws after implantation of the femoral component with long stem. Cast fixation performed during two weeks and full weight bearing permitted at 7 weeks after surgery. Her JOA score was slightly improved 50 due to other knee problems at 9 months after surgery, her right mechanical FTA was decreased to 173, and she received left simultaneous femoral supra-condyle valgus osteotomy with TKA as the same technique at April of this year. She has been receiving rehabilitation at now. Most causes of varus knee deformity are defect or deformity of medial tibial condyle and TKA for theses cases are not difficult to use tibial augment devices. However the cases like our presentation need supra-femoral condyle osteotomy before TKA. It was easy and useful to use intramedullary guide for valgus osteotomy as temporary reduction and fixation then performed mono-cortical locking plate fixation before TKA.Case presentation
Conclusions
Many TKA instruments were developed in these days. Distal femoral cutting guide using intra-medullary system were divided into two methods, from anterior or medial. Many companies employed anterior cutting guide, however these guides have a disadvantage of wide skin and quadriceps incision. Only Zimmer provided medial cut guide which performed short skin and quadriceps incision. However, reference point (medial femoral condyle) will be a risk of imprecise cutting for a medial condyle defect cases. We tried L-shaped new distal femoral cutting guide, reference point will be both femoral condyle and cutting from antero-medial side. The purpose of this study was to prove usefulness of the new guide. Twenty-nine knees were employed in this study. All knees were treated with Optetrak knee system (Exactec). Surgical methods were as follows, mid line skin incision, short para-patellar deep incision, no patellar resurfacing, PS type implant and cement fixation were employed. 13 knees were used original anterior cutting guide (O group) and 16 knees were used new antero-medial cut guide (N group). Study items were length of skin incision, length of Quadriceps incision, surgical time, JOA score, and component tilting angles (implant position were compared to femoral axis with AP and lateral view of roentgenograms).Purpose
Materials and Methods
The purpose of this study is to clarify optimal timing of anterior cruciate ligament (ACL) reconstruction from the point of view of meniscus injury. One hundred thirty-five ACL injuries (under 40 years of age) were analyzed in this study. All knees had undergone primary reconstruction without other ligament injury, and follow-up arthroscopy. ACL reconstruction was performed by the semitendinosus and gracilis method. The rehabilitation protocol was based on that of Shelbourne. Cases were divided into 4 groups by the period from injury to reconstruction. Nineteen knees were of the acute phase, which is within 1 month from the injury to reconstruction. Thirty-one knees were of the subacute phase, which is from 1 month over to reconstruction. Thirty-one knees were of the subacute phase, which is from 1 month over to 3 months from the injury to reconstruction. Forty knees were of the subchronic phase, which is from 3 months over to 1 year from the injury to reconstruction. Forty-five knees were of the chronic phase, which is over 1 year from the injury to reconstruction. We compared arthroscopic findings as well as clinical follow-up results of each phase. The rate of lateral meniscus injury were 84% in the acute phase, 39% in the subacute phase, 58% in the subchronic phase, and 51% in the chronic phase. The rates of medial meniscus injury were 32% in the acute phase, 29% in the subacute phase, 53% in the sub-chronic phase, and 60% in the chronic phase. Horizontal tear and degenerative tear of the lateral meniscus were increased with time. Osteoarthritic change at follow-up arthroscopy was observed 3 knees in the acute phase, 4 knees In the subacute phase, 8 knees In the subchronic phase, and 13 knees in the chronic phase. There was no difference between clinical results of our ACL reconstruction in the acute phase and chronic phase. ACL reconstruction in the acute phase was the effective method for preventing secondary osteoarthritis after medial meniscus injury.
